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Biomedical subjects

Adam Balen

Publications and source records attributed to Adam Balen.

7 recordsLinked to original sources
PubMed2003

Polycystic ovary syndrome--a systemic disorder?

Polycystic ovary syndrome (PCOS) is the commonest endocrine disturbance affecting women. There is considerable heterogeneity of symptoms and signs amongst women with PCOS and for an individual these may change over time. PCOS is familial and genetics appear to be associated with disturbances of insulin secretion. Polycystic ovaries can exist without clinical signs of the syndrome, which may then become expressed over time. There are a number of interlinking factors that affect expression of PCOS. A gain in weight is associated with a worsening of symptoms whilst weight loss will ameliorate the endocrine and metabolic profile and symptomatology. Women with PCOS are characterized by the presence of insulin resistance, central obesity and dyslipidaemia, which appears to place them at a higher risk of developing diabetes as well as cardiovascular disease. A number of studies have confirmed the higher incidence of diabetes, although they have not shown a higher risk of mortality from ischaemic heart disease (IHD). Cross-sectional studies have demonstrated a significant association between PCOS and IHD. Prospective, long-term longitudinal studies confirming this risk are still awaited. Weight loss remains the most effective first line therapeutic intervention in women with PCOS and recently the use of insulin sensitizing agents has demonstrated benefit.

Cardiovascular Diseases↗
PubMed2003

Ovulation induction--optimizing results and minimizing risks.

The aim of ovulation induction therapy should be, wherever possible, to correct the underlying disturbance and achieve safe, repeated unifollicular ovulation to achieve the live birth of singleton babies. This article outlines the main causes of anovulatory infertility but deals mostly with the management of anovulatory polycystic ovary syndrome (PCOS), which is the most common problem to confront specialists in reproductive medicine. PCOS is associated with insulin resistance, particularly in those who are overweight. Thus, strategies to achieve weight loss and improve insulin sensitivity, including the use of drugs such as metformin, enhance reproductive function. Therapies to induce ovulation involve first the use of the anti-oestrogen clomiphene citrate. For those who fail to ovulate in response to clomiphene citrate, the principal options include parenteral gonadotrophin therapy or laparoscopic ovarian diathermy.

Adult↗
PubMed2002

Is there a risk of prion disease after the administration of urinary-derived gonadotrophins?

Concern has been raised recently about the possibility of prion proteins appearing in the urine of animals and, possibly, humans affected by prion disease [scrapie, bovine spongiform encephalopathy (BSE) and Creutzfeldt Jakob disease (CJD)]. A debate has started in which the suggestion has been made that the purification of human urine for the provision of gonadotrophins should be discontinued. The alternative would be to use recombinantly-derived gonadotrophin preparations. The recombinant products, however, rely upon bovine serum during the cell culture process and could potentially also be exposed to abnormal prion proteins. It is reassuring that the different types of gonadotrophin preparations that are currently available are produced with either urine or bovine serum that is sourced from countries that at the present time appear to be free of BSE and new variant CJD. We can therefore be reassured that the gonadotrophins that we use therapeutically appear to be equally safe.

Drug Costs↗
PubMed2002

What is polycystic ovary syndrome? Are national views important?

Polycystic ovary syndrome (PCOS) is a true syndrome, being a heterogeneous collection of signs and symptoms that gathered together form a spectrum of a disorder with a mild presentation in some, whilst in others there is a severe disturbance of reproductive, endocrine and metabolic function. There has been much debate about phenotype and, more recently, genotype. There has also been scepticism in some quarters, with a feeling that we may be looking at one end of a spectrum that is in reality 'normal', or perhaps a consequence of the modern disease of obesity. Whilst the polycystic ovary is at the centre of the syndrome, it is external effects such as hyperinsulinism, that influence its expression. There is no consensus on the definition of PCOS and so studies that compare epidemiology and treatments often have very different starting points, and so cannot be compared. In this debate we wish to re-explore our current thinking on PCOS, with a particular emphasis on the British and European perspective and invite others to contribute to the discussion which could form the basis for an international consensus.

Ethnicity↗
PubMed2000

Ovulation induction for polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the commonest cause of anovulatory infertility. Various factors influence ovarian function, and fertility is adversely affected by an individual being overweight or having high serum concentrations of LH. Strategies to induce ovulation include weight loss, oral anti-oestrogens (principally clomiphene citrate), parenteral gonadotrophin therapy and laparoscopic ovarian surgery. There have been no adequately powered randomized studies to determine which of these therapies provides the best overall chance of an ongoing pregnancy. Women with PCOS are at risk of ovarian hyperstimulation syndrome (OHSS) and so ovulation induction has to be monitored carefully with serial ultrasound scans. The recognition of an association between hyperinsulinaemia and PCOS has resulted in the use of insulin sensitizing agents, such as metformin, which appear to ameliorate the biochemical profile and improve reproductive function.

Journal Article↗
PubMed2000

Fertility nurses doing embryo transfers -- what is the impact of training?

It has been demonstrated that embryo transfer during IVF treatment can be performed competently and successfully by nurses (Barber et al., 1996). The present study has examined the success of nurses in training using the standardized protocol of this Unit. Initially, three nurses (two experienced (training completed) and one inexperienced (training ongoing)) each performed 80 transfers, which were standardized to three embryos replaced per transfer. The study aimed to establish whether a standardized procedure was undertaken by the nurses and to assess the influence of one inexperienced nurse performing the procedure. A further study (study 2) was performed to assess the influence of three inexperienced nurses against three experienced nurses undertaking the same procedures. In study 1, the pregnancy rates were 27.5%, 38.8% and 40.0% and there was no significant difference in the clinical pregnancy rates. In study 2, the pregnancy rates were 18.7%, 20.0% and 20.0% for the inexperienced nurses, and 26.3%, 30.0% and 32.5% for the experienced nurses. There was no significant difference in the clinical pregnancy rates within the inexperienced group or the experienced group. When the results of the three inexperienced nurses were grouped and were compared with those of the three experienced nurses, the pregnancy rates were 19.5% and 29.5%, respectively (P < 0.02). It has been shown that good clinical pregnancy rates can be achieved when nurses perform embryo transfer. There is no significant effect on clinical results when one nurse is in training; however, because of the expected learning curve, when three nurses train together a more significant effect is observed.

Journal Article↗